UO di Clinica Medica, Arcispedale S Anna, Ferrara, Italy.
Int Urol Nephrol. 2011 Dec;43(4):1171-8. doi: 10.1007/s11255-010-9821-9. Epub 2010 Sep 2.
In dialysis patients, coronary angiography (CA) predicts major adverse coronary events (MACE) better than non-invasive tests. The aim of this study was to investigate in such patients the relationship between coronary atherosclerotic damage shown by angiography and MACE, during an average follow-up period of more than 5 years.
Coronary angiography was performed in 63 dialysis patients (mean age 56 ± 12 years, 49 men); 37 subjects awaiting kidney transplantation had no history of cardiac disease, whereas the remaining 26 patients had clinical evidence of coronary artery disease (CAD). During a follow-up period of 62 ± 20 months (range 12-109), all the MACE were recorded. Statistical analysis was carried out by dividing the patients into two groups, those who had MACE (MACE group) and those who were free of cardiac events (FCE group). Severe CAD on CA was defined as luminal stenosis ≥ 75% in at least one vessel. Logistic regression analysis and Cox regression analysis were carried out in order to evaluate which variable was associated with MACE.
At the end of follow-up, 17 subjects had MACE and severe CAD was shown in the epicardial arteries of 31 patients (49%). Compared to the FCE group, the MACE group had older age (65 ± 10 vs 53 ± 11 years, P = 0.002), lower diastolic blood pressure (79 ± 7 vs 85 ± 7 mmHg, P = 0.0037), higher prevalence of CAD (82 vs 30%, P = 0.0002) and cerebrovascular disease (41 vs 15%, P = 0.0278). Coronary artery damage was higher in the MACE group than in the FCE group. Logistic and Cox regression analyses showed that age was the only variable independently associated with MACE (OR 1.109 95% CI 1.022-1.204, P = 0.0133, hazard ratio 1.066 95% CI 1.010-1.125, P = 0.02, respectively). After removal of age from the model, MACE were independently associated with haemodynamic stenosis of coronary arteries (OR 7.429 95% CI 1.829-30.173, P = 0.005, hazard ratio 5.992 95% CI 1.655-21.698, P = 0.006, respectively). Event-free survival was much better in the 37 renal transplant candidates with no history of CAD than in the 26 patients who had clinical evidence of CAD.
This observational study confirms that in dialysis patients coronary atherosclerotic damage shown by angiography is strongly related to MACE and that age and severe CAD are major risk factors for MACE.
在透析患者中，冠状动脉造影（CA）比非侵入性检查更能预测主要不良冠状动脉事件（MACE）。本研究的目的是在平均随访时间超过 5 年的情况下，研究此类患者中通过血管造影显示的冠状动脉粥样硬化损伤与 MACE 之间的关系。
对 63 名透析患者（平均年龄 56 ± 12 岁，49 名男性）进行了冠状动脉造影；37 名等待肾移植的患者无心脏病史，而其余 26 名患者有冠状动脉疾病（CAD）的临床证据。在 62 ± 20 个月的随访期间（范围 12-109），记录了所有 MACE。通过将患者分为 MACE 组（MACE 组）和无心脏事件组（FCE 组），进行统计学分析。严重 CAD 定义为至少一条血管管腔狭窄≥75%。进行逻辑回归分析和 Cox 回归分析，以评估哪个变量与 MACE 相关。
随访结束时，17 名患者发生了 MACE，31 名患者（49%）的心脏动脉有严重 CAD。与 FCE 组相比，MACE 组年龄较大（65 ± 10 岁比 53 ± 11 岁，P = 0.002），舒张压较低（79 ± 7 毫米汞柱比 85 ± 7 毫米汞柱，P = 0.0037），CAD 患病率较高（82%比 30%，P = 0.0002）和脑血管疾病（41%比 15%，P = 0.0278）。MACE 组的冠状动脉损伤高于 FCE 组。逻辑和 Cox 回归分析表明，年龄是唯一与 MACE 相关的变量（OR 1.109，95%CI 1.022-1.204，P = 0.0133，风险比 1.066，95%CI 1.010-1.125，P = 0.02，分别）。从模型中排除年龄后，MACE 与冠状动脉血流动力学狭窄独立相关（OR 7.429，95%CI 1.829-30.173，P = 0.005，风险比 5.992，95%CI 1.655-21.698，P = 0.006，分别）。无 CAD 病史的 37 名肾移植候选者的无事件生存率明显优于有 CAD 临床证据的 26 名患者。
这项观察性研究证实，在透析患者中，血管造影显示的冠状动脉粥样硬化损伤与 MACE 密切相关，年龄和严重 CAD 是 MACE 的主要危险因素。
